MEDICAL MATTERS:Why the hospital theatre deserves a standing ovation
THE WORD “theatre” has a grand ring to it, and needs an actor’s voice to give it the full flavour. Surgeons can give “theatre” an impressive ring too.
Take the case of your typical inflamed appendix. The junior mutters the findings, the surgeon asks an additional question, pokes at the tummy and then cries, “theatre!” and immediately the show begins.
It is the ultimate conversation stopper and action starter. Doors fly open, nurses scurry, lights are switched on and trolleys are wheeled into place.
“Theatre,” staff whisper, “he’s gone to theatre.” The American acronym for operating room – OR – has not got the same resonance. “OR” sounds like the utterance of a Somerset farmer in a good mood. “Theatre” has history, grandeur and drama.
The word “surgeon” also has some style: “What do you do?”
“I’m a surgeon”
“Oh!” (Try making a joke of that).
For many years at the mention of the word “surgeon”, the image of James Robertson Justice in the Doctor films would immediately spring to mind. He was a bearded, terrifyingly alpha male with a bad temper and an abrupt manner. His portrayal of a typical surgeon was accurate enough, if a trifle understated. But he knew what he was doing, like our man dealing with the appendicitis.
Back in theatre, the doors are closed and the actors take the stage. Most surgeons, unfortunately, are men and they like their toys. They have favourite instruments and gadgets; stools (you sit down in some operations), clogs (yes, clogs), masks and gowns.
The classic mistake for the medical student on their first visit to theatre is to wear the surgeon’s personal and treasured clogs. This is the equivalent of asking the foreman on a building site for a new bubble for the spirit level and will provoke a temper tantrum of epic proportions.
The theatre staff, who are only delighted the boss is venting his spleen on someone else, continue to flit about, preparing the scene.
Taps gush. The kindly anaesthetist – who is always for some reason as different in looks and demeanour from the surgeon as it is possible to be – puts the patient to sleep and attaches him to an array of quietly beeping machinery without fuss. She is a silent angel. Nurses flit by, as cool and competent as Peter Stringer, and the porters quietly wheel everything to centre stage.
When the surgeon has togged out, the student gets a nasty shock. The august and hitherto well-dressed surgeon is not only without a tie, but in a pair of baggy blue pyjamas with a plunging neckline and short sleeves. As well as the scrubs, he is wearing a bandana-style hat, like Bruce Springsteen’s bass guitarist, and what looks like a baby’s bonnet is tied with string under his nose.
Scrubs, as they are now called, look well on the young and willowy; the very people, in fact, who are at the bottom of the rigid theatre hierarchy. Which may be why everyone shouts at them.
Scrubs are anything but flattering to those with fat bums, pot-bellies, wobbling jowls and hairy arms – those
in charge. This is why I have long suspected scrubs are designed and made by anarchists, who are determined to overthrow the world order.
The drama now takes a religious turn.
First is the ritual scrubbing of the hands in a practised and ostentatious manner. Disinfectant supplies the
smell, and the beeping machinery the bells. The gowning of the surgeons is another ritual, each proffering the other an apron string in a gloved hand, before prescribing a stately pirouette. The patient is the sacrificial lamb, the nurses the handmaidens. The theatre lights are adjusted and the central performance begins.
By now the anaesthetist has everything arranged and gives the surgeon the nod. His concentration is now unwavering as he carries the lead role, all the lines and twists and turns of the plot: the stagecraft, the action and the dialogue. This is Formula One, this is tightrope walking, this is sinking the ball in the top left-hand pocket.
Forgive it all, the temper, the car obsession, the hairy arms. In every hospital in every town lucky enough to have a hospital, the surgeon is playing god, rearranging the innermost person, and restructuring the very stuff of life.
“I had my appendix out.” It sounds banal. Except if you had not had your appendix out you would have died.
Give thanks every day of your life for, just because in every hospital in every town
the operations go on, it does not make them any less miraculous. Tom Crean and Houdini were pretty good survivors, but the appendix killed them both.
The surgeon finishes stitching. He is now in great form and cracks a joke about the clogs.
The patient is wheeled in one direction, the appendix in another.
The scenery is rearranged. The group disperses until the next time, when they’ll do it all again.
Pat Harrold is a GP practising in Co Tipperary
